Rates of preterm births in the United States are much higher than in other wealthy nations. A systematic review of global preterm birth published in 2019 showed that the U.S. was in the top ten for preterm births in 2014, ranking seventh, between Pakistan and Ethiopia. Another study found that in part, the “stresses of racism and income disparity” may be exacerbating bad outcomes for American moms and babies.

As Sema Sgaier and Jordan Downey point out in a new Times Opinion article about the “shameful trends” in U.S. maternal health, mothers who, like Butler, deliver their babies in Alabama, are particularly at risk for preterm birth, along with other major issues. “One out of every five women of reproductive age in Southern states,” they write, “live in counties with a high risk of death and other poor maternal health outcomes, such as postpartum hemorrhage, pre-eclampsia and preterm birth.”